Respiratory admissions and impact of COVID-19 lockdowns for children with severe cerebral palsy.

Aim

To explore factors contributing to the burden of respiratory admissions in children with severe cerebral palsy (CP) by comparing admissions to a single tertiary paediatric hospital before, during, and after the period of social restrictions implemented to reduce transmission of COVID-19 (lockdown period).

Method

For this observational study, three severe CP cohorts (pre-lockdown, lockdown, post-lockdown) were identified from a state-wide cerebral palsy register and linked to patient-level clinical and demographic data. Medical records were manually searched to identify respiratory hospitalizations. Frequency and details of admissions were compared across the three 2-year periods.

Results

During the lockdown period, there were 24 hospitalizations for respiratory illness per 100 children compared to 37 and 47 in the pre-lockdown and post-lockdown periods (p < 0.001). Respiratory viruses (excluding picornaviruses) were detected in only 7% of lockdown admissions compared to 24% pre-lockdown and 30% post-lockdown. Sputum sampling was performed in 34% of admissions with gram-positive bacteria cultured in 6% admissions and gram-negative bacteria only in 18%.

Interpretation

The study findings highlight an important dynamic contribution of viral infections to respiratory illnesses in children with severe CP and the potential to improve outcomes with personalized approaches based on defining individual factors predisposing to recurrent respiratory admissions.

References:

• Smithers‐Sheedy H, Waight E, Goldsmith S, et al. Declining trends in birth prevalence and severity of singletons with cerebral palsy of prenatal or perinatal origin in Australia: A population‐based observational study. 2022; 64: 1114–22.
• Havers F, Fry AM, Chen J, et al. Hospitalizations attributable to respiratory infections among children with neurologic disorders. J Pediatr 2016; 170: 135–41.e1–5.
• Inal‐Ince D, Savci S, Arikan H, et al. Effects of scoliosis on respiratory muscle strength in patients with neuromuscular disorders. Spine J 2009; 9: 981–6.
• Marpole R, Blackmore AM, Gibson N, Cooper MS, Langdon K, Wilson AC. Evaluation and management of respiratory illness in children with cerebral palsy. Front Pediatr 2020; 8: 333.
• Kürtül Çakar M, Cinel G. The respiratory problems of patients with cerebral palsy requiring hospitalization: Reasons and solutions. Pediatr Pulmonol 2021; 56: 1626–34.